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The Fear of Contagion and the Attitude Toward the Restrictive Measures Imposed to Face COVID-19 in Italy: The Psychological Consequences Caused by the Pandemic One Year After It Began

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The pandemic nature of COVID-19 has caused major changes in health, economy, and society globally. Albeit to a lesser extent, contingent access to shops and places to socialize the imposition of social distancing and the use of indoor masks is measures still in force today (more than a year after the start of the pandemic), with repercussions on economic, social, and psychological levels. The fear of contagion, in fact, has led us to be increasingly suspicious and to isolate ourselves from the remainder of the community. This has had repercussions on the perception of loneliness, with significant psychological consequences, such as the development of stress, anxiety, and, in extreme cases, depressive symptoms. Starting from these assumptions, this research was developed with the aim of deepening the perceptions that the participants have of their own mental health, loneliness, fear linked to contagion, and attitudes toward imposed social distancing. In particular, we wanted to analyze whether there is a relationship between perceived fear and the perceived level of mental health, loneliness, and attitude toward social distancing. Finally, we wanted to analyze whether there are differences related to gender, age, marital status, current working mode, and educational qualifications. The research, performed after the diffusion of the vaccination in Italy, lasted 14 days. The participants were 500 Italians who voluntarily joined the study and were recruited with random cascade sampling. The research followed a quantitative approach. The analyzed data, from participants residing throughout the national territory, allow us to return the picture of the perceptions that Italians have of the fear of contagion, of their level of mental health, of loneliness and of their attitude toward social distancing. In particular, the data show that fear of COVID-19 is an emotional state experienced by the entire population and that young people have suffered more from loneliness and have been less inclined to accept the imposed social distancing. The data that emerged should make policymakers reflect on the need to find functional strategies to combat COVID-19 or other health emergency crises whose effects do not affect the psychological wellbeing of the population.
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Frontiers in Psychology | www.frontiersin.org 1 February 2022 | Volume 13 | Article 805706
ORIGINAL RESEARCH
published: 24 February 2022
doi: 10.3389/fpsyg.2022.805706
Edited by:
Gustavo Carlo,
University of Missouri, UnitedStates
Reviewed by:
Adolfo Di Crosta,
University of Studies G. d’Annunzio
Chieti and Pescara, Italy
Valentina Lucia La Rosa,
University of Catania, Italy
*Correspondence:
Nadia Rania
nadia.rania@unige.it
Specialty section:
This article was submitted to
Health Psychology,
a section of the journal
Frontiers in Psychology
Received: 30 October 2021
Accepted: 10 January 2022
Published: 24 February 2022
Citation:
Rania N and Coppola I (2022) The
Fear of Contagion and the Attitude
Toward the Restrictive Measures
Imposed to Face COVID-19in Italy:
The Psychological Consequences
Caused by the Pandemic One Year
After It Began.
Front. Psychol. 13:805706.
doi: 10.3389/fpsyg.2022.805706
The Fear of Contagion and the
Attitude Toward the Restrictive
Measures Imposed to Face
COVID-19in Italy: The Psychological
Consequences Caused by the
Pandemic One Year After It Began
NadiaRania * and IlariaCoppola
Department of Education Sciences, University of Genoa, Genoa, Italy
The pandemic nature of COVID-19 has caused major changes in health, economy, and
society globally. Albeit to a lesser extent, contingent access to shops and places to
socialize the imposition of social distancing and the use of indoor masks is measures
still in force today (more than a year after the start of the pandemic), with repercussions
on economic, social, and psychological levels. The fear of contagion, in fact, has led
us to beincreasingly suspicious and to isolate ourselves from the remainder of the
community. This has had repercussions on the perception of loneliness, with signicant
psychological consequences, such as the development of stress, anxiety, and, in
extreme cases, depressive symptoms. Starting from these assumptions, this research
was developed with the aim of deepening the perceptions that the participants have of
their own mental health, loneliness, fear linked to contagion, and attitudes toward
imposed social distancing. In particular, wewanted to analyze whether there is a
relationship between perceived fear and the perceived level of mental health, loneliness,
and attitude toward social distancing. Finally, wewanted to analyze whether there are
differences related to gender, age, marital status, current working mode, and educational
qualications. The research, performed after the diffusion of the vaccination in Italy,
lasted 14 days. The participants were 500 Italians who voluntarily joined the study and
were recruited with random cascade sampling. The research followed a quantitative
approach. The analyzed data, from participants residing throughout the national territory,
allow us to return the picture of the perceptions that Italians have of the fear of contagion,
of their level of mental health, of loneliness and of their attitude toward social distancing.
In particular, the data show that fear of COVID-19 is an emotional state experienced by
the entire population and that young people have suffered more from loneliness and
have been less inclined to accept the imposed social distancing. The data that emerged
should make policymakers reect on the need to nd functional strategies to combat
Rania and Coppola COVID-19: Fear and Psychological Consequences
Frontiers in Psychology | www.frontiersin.org 2 February 2022 | Volume 13 | Article 805706
COVID-19 or other health emergency crises whose effects do not affect the psychological
wellbeing of the population.
Keywords: COVID-19, Italy, psychological impact, fear of contagion, loneliness, mental health, social distance
INTRODUCTION
The COVID-19 pandemic, which began in February 2020in
Italy, has had a dramatic impact on health, economic, and
social levels. People have faced profound changes imposed
by governments to reduce contagion, including the use of
masks, social distancing, and more or less stringent lockdowns
that have been repeated over the course of more than a
year with different modalities and levels of restrictions.
These changes have led to decidedly strong and invasive
changes in everyday life with heavy repercussions on a
psychological level In Italy, as of December 27, 2021,
according to the data reported by the civil protection.1 The
number of cases is equal to 5,647,313 and even if the
number of recovered is significantly higher than number
of dead; to this day, the number of infected is constantly
increasing. The use of masks maintaining a distance of at
least 1 m and vaccines is some of the measures taken by
the government to counter the spread of the virus. The
fear of contagion toward the most fragile people (those
that are elderly or vulnerable), but also toward ourselves,
has led us to be increasingly suspicious and to isolate
ourselves from the remainder of the community for fear
that others could be a danger to our safety. This has had
repercussions on the perception of loneliness, felt particularly
by the population in this period, leading to psychological
consequences, such as the development of stress, anxiety
(Porcelli, 2020; Tull et al., 2020; Rania and Coppola, 2021),
and, in extreme cases, depressive symptoms. As stated by
Briscese et al. (2020) in order to try to counter the spread
of COVID-19, governments have applied measures of social
distancing relying on the will of citizens to respect these
restrictions. From the research conducted by the authors,
it emerges that the expectations that people have about
the expected duration of the lockdown influence their
willingness to comply: if the restrictive measures are applied
for a longer time than expected, their willingness to adhere
to it will be less. In connection with the previous outbreak
caused by the Syndrome (SARS), as noted by Wu et al.
(2005), a risk factor for the development of depressive
symptoms is the direct knowledge of people with SARS or
having survived the disease. Finally, some authors have
highlighted how the fear experienced during COVID-19
has had repercussions on peoples mental health, manifesting
in feelings of anxiety, loneliness, uncertainty, and panic
(Fitzpatrick et al., 2020).
1
https://opendatadpc.maps.arcgis.com/apps/dashboards/
b0c68bce2cce478eaac82fe38d4138b1
Fear of COVID-19 and Loneliness: Risk
and Protection Factors
e COVID-19 pandemic has had repercussions, in the present,
but it will also have them in the future, not only on people’s
health, but also on dierent areas of life, including the economic
and social sphere (Ceccato et al., 2021) with a signicative
level of traumatic stress, in women more than in men (La
Rosa et al., 2021).
The fear experienced during the COVID-19 pandemic
has had repercussions on psychological wellbeing: as noted,
in fact, by Duong (2021), both fear and anxiety during the
pandemic were determining factors in predicting forms of
psychological distress, making emerging difficulties in mental
wellbeing. Starting from the theory of attachment and the
management of terror, referring to the pandemic situation
we are going through, Steele (2020) suggests how the fear
and anxiety experienced in one’s life are closely connected,
in addition to the lack of coherent information, to fear of
losing loved ones. Furthermore, Di Crosta et al. (2020)
found that female gender, the perception of low economic
stability and the fear of contagion are factors that negatively
affect the psychological fallout due to COVID-19 and are
predictors of a high symptoms of post-traumatic stress
disorder. In the literature, it has been highlighted that
infectious diseases are associated with fear, anxiety, and
other psychological disorders (Cheng et al., 2004; Duong,
2021). COVID-19, as an infectious disease, can cause
psychological distress, depression, anxiety, and fear (Lee and
Crunk, 2020; Satici et al., 2020a; Duong, 2021). Research
conducted by Di Crosta et al. (2021) shows how fear and
anxiety about COVID-19 are predictors of changes in
consumers, who under the effect of these emotions would
feel the need to purchase goods necessary for survival. Fear,
in particular, is defined as an emotional state, a response
to a general malaise that is not well identifiable or quantifiable
and clinically difficult to manage, particularly when it is
linked to events of a broader nature, such as those related
to terrorism and public health (Fitzpatrick et al., 2020).
These cases include the COVID-19 pandemic, a direct threat
that causes individual reactions. The speed and in-depth
understanding of the exact methods of contagion have led
people to feel panic and fear (Deniz, 2021), including the
fear of being infected or infecting others, the risk of death,
the loss of loved ones, and not receiving adequate care
(Montemurro, 2020; Saricali etal., 2020; Satici etal., 2020b;
Deniz, 2021). Several studies performed during the pandemic
found that there was a progressive increase in COVID-19
fear around the world (Knipe et al., 2020) and that there
is an association between fear and depression (Daly and
Robinson, 2020; Lee et al., 2020; Lee and Crunk, 2020;
Satici et al., 2020; Ye et al., 2020), which in severe cases
Rania and Coppola COVID-19: Fear and Psychological Consequences
Frontiers in Psychology | www.frontiersin.org 3 February 2022 | Volume 13 | Article 805706
can lead to suicide (Dsouza etal., 2020). Furthermore, during
the COVID-19 pandemic, every society faced multiple
challenges, including the pressure of social distancing and
attention to contagion (Duong, 2021).
e most fragile population has been the most aected by
COVID-19 and the eects caused by the restrictions imposed
to limit its spread. Older people suer most from the negative
eects of COVID-19. Restrictive measures, fear, and loneliness
have had negative repercussions on the resilience of people
aged 65 and over, thus compromising their physical and
psychological wellbeing (Plagg et al., 2020; Set, 2020; Savci
et al., 2021). Esposito et al. (2021) underline how young
participants due to the social restrictions imposed suered of
anxiety and depression; furthermore, Biviá-Roig et al. (2020)
found that pregnant women during lockdowns suered most
from anxiety and depression. Rodríguez-Rey et al. (2020),
moreover, underline how stress caused by COVID-19 is associated
with alcohol use, more in women than in men.
Research conducted by Commodari and La Rosa (2020) highlights
how young people have a lower perception of risk because
they see COVID-19 as a less risky disease for them. However,
previous research has shown that social isolation, regardless
of age, is closely linked to symptoms of anxiety and depression
(Matthews etal., 2019; Santini etal., 2020). Furthermore, during
the pandemic, some authors found that the lockdowns caused
mental illness even in the youngest (Lee etal., 2020; Coppola
et al., 2021). Additionally, other studies (Porcelli, 2020; Tull
et al., 2020) have found that being forced to stay at home
has led to the development of greater stress, social isolation,
loneliness, and anxiety about one’s health. Social distancing,
in fact, one of the impositions dictated by many states in the
hope of curbing the spread of the virus, has been dened as
a possible factor that has contributed to the increase in
dissatisfaction, anxiety (De Pedraza etal., 2020; Duong, 2021),
and loneliness, with negative eects on wellbeing of the population
(Boursier etal., 2020). Although social isolation and loneliness
represent two distinct concepts, they are closely interrelated
and are potential risk factors for suicide during and aer the
pandemic (Allan et al., 2021).
MATERIALS AND METHODS
e present research follows quantitative and exploratory
methods. e questionnaire, administered online with the
use of Microso Forms platform in open survey, was provided
via a link sent by email, WhatsApp, discussion forums, and
social networks, such as Facebook. e compilation of the
protocol, via mobile phone or computer, took on
average about 20 min per participant. No type of incentive
was provided for the participants, who joined exclusively on
a voluntary basis.
Before sharing the link, the researchers themselves lled
out the questionnaire, in order to test its feasibility and
functionality both through the use of smartphones and with
a laptop and desktop pc. Both from the mobile phone and
from the computer, the participant viewed four questions per
page for a total of six pages. For each page, there was the
possibility to go back to check or modify the answers given.
e convenience sample was recruited through random
cascade sampling, starting from some subjects known to the
research group, and involved participants who were at least
18 years old and Italian-speaking citizens.
e data were collected in accordance with the ethical
recommendations of the Declaration of Helsinki and in
compliance with the American Psychological Association (APA)
standards for the treatment of human volunteers.
e questionnaire was proposed throughout Italy, thanks
to its dissemination through the use of social media; however,
most of the participants who lled out the questionnaire are
from the same region as those who conducted the research.
e research, of an exploratory nature, does not want to return
a representative image of the Italian population but rather to
give a picture of the perceptions of the population in relation
to perceived fear and their own mental health (Lagomarsino
et al., 2020).
Before starting the completion of the questionnaire, on an
introductory page, the objectives of the study were described,
the themes proposed, and an informed consent was oered
to them through which the participants were asked to join
voluntarily and they were informed that they could withdraw
at any moment by closing the browser window. Only by
accepting the consent could the participants start lling out
the questionnaire. In addition, each participant was asked to
build a code so that they could be contacted for further
research. e code, therefore, allowed us to verify that the
same participant has not lled out the proposed questionnaire
several times.
e research was performed for 1 month and was carried
out in April 2021; approximately, two-thirds of the questionnaires
were compiled on the rst 3 days of the questionnaire launch.
Only fully completed questionnaires were analyzed.
Measures
Fear of COVID-19 Scale
e FCV-19S (Ahorsu et al., 2020; Italian validation, Soraci
et al., 2020) included seven items with a ve-point Likert
scale (from 1 = strongly disagree to 5 = strongly agree) that assess
the fear of COVID-19. e higher the score, the greater the
fear of COVID-19. e scale showed good internal consistency
(α = 0.85).
Mental Health
e General Health Questionnaire with 12 items (GHQ-12)
scale measures the state of mental health over the previous
few weeks and was developed by Goldberg in the 1970s and
validated in Italy by Piccinelli etal. (1993). e 12-item version,
GHQ-12, is the most widely used (Elovanio et al., 2020).
Participants had to report whether they experienced a particular
symptom of mental distress according to a four-point Likert-
type scale (“not at all,” “less than usual,” “more than usual,
or “rather more than usual”). e six positive items were
corrected. Participants who answered “rather more than usual
Rania and Coppola COVID-19: Fear and Psychological Consequences
Frontiers in Psychology | www.frontiersin.org 4 February 2022 | Volume 13 | Article 805706
or “more than usual” scored 1, while those who answered
“less than usual” or “not at all” scored 0 (the so-called “0-0-1-1
method”; Elovanio et al., 2020). As pointed out by Piccinelli
etal. (1993), this type of scoring, called conventional, “eliminated
the problem of “middle and end users” and that of the “conceptual
distance” between positions on the response scale. A total score
ranged from 0 to 12 points; higher scores indicate worse health.
e scale showed good internal consistency (α = 0.82).
Loneliness Scale
We used the ree-Item Loneliness Scale developed by Hughes
et al. (2004) from the revised UCLA Loneliness Scale (Russell
et al., 1980) in the Italian version of Solano and Coda (1994).
It is a short scale for measuring loneliness in large surveys,
and it assesses feelings of isolation, disconnectedness, and not
belonging. Respondents are rated on a three-point Likert scale
from 1 = hardly ever to 3 = oen, with a total score ranging
from 3 to 9 points; higher scores indicate greater loneliness.
e three-item scale showed good internal consistency (α = 0.72).
Coronavirus Social Distance Attitudes Scale
e scale was composed of 14 items with eight expressing support
to social distancing (Positive Attitudes, example item is “it is our
duty as good citizens to follow social distance orders,”) and six
expressing opposition to social distancing (Negative Attitudes,
example item is “social distance orders violate my individual
rights”; An et al., 2021). Items were answered using a ve-point
Likert scale (from 1 = strongly disagree to 5 = strongly agree). Both
the positive social distance scale (α = 0.81) and negative social
distance scale showed good internal consistency (α = 0.84).
e demographic section was composed of eight items exploring
the demographic characteristics of the participants, their
instruction level, and information about their work during the
COVID-19 pandemic.
Data Analysis
Descriptive statistics were calculated for sociodemographic
characteristics, consisting of percentages, while the scores
of Fear of COVID-19, General Health Questionnaire (GHQ-
12), Loneliness, and Positive and Negative Social Distance
Attitudes were expressed as means and standard deviations.
To investigate the gender dierences in relation to the
constructs investigated, t-tests were used for independent
samples. To compare the dierences between our participants
and the Italian normative sample and therefore in relation
to the prepandemic data, t-tests were conducted for single
samples. While variance analysis was used to investigate the
dierences between groups (age, marital status, current work
mode, and educational qualication) in relation to the variables
investigated, with post-hoc Tukey (for homogeneous variances)
or Games-Howell (for non-homogeneous variances) between
group comparisons in case of a signicant overall F-value.
Appropriate eect size statistics that adjust for dierences
in group sizes were obtained of Cohen’s d for t-tests and
h
p
2 for ANOVAs. To explore the relationship between variables
investigated, correlation analyses Pearson correlation coecient
was conducted. We used multiple linear step way regressions
to calculate the univariate associations. SPSS (v. 20) soware
was used for these analyzes.
A post-hoc power analysis to evaluate power of this study
was conducted using the soware package, GPower (Faul and
Erdfelder, 1992). e sample size of 500 was used for the
statistical power analyses and a ve predictor variable equation
was used as a baseline. e recommended eect sizes used
for this assessment were as follows: ssmall (f2 = 0.02), medium
(f2 = 0.15), and large (f2 = 0.35; see Cohen, 1977). e alpha
level used for this analysis was p < 0.05.
Participants
A total of 500 adults from across Italy responded to the online
questionnaire. Most respondents were women (86%), young
adults (age M = 39.52 years, SD = 16.58; range 20–89), unmarried
(47.7%), or married/cohabiting (44.7%), without children (62.4%),
and with a secondary school diploma (41.9%).
e post-hoc analyses revealed the statistical power of this
study was 0.67 for detecting a small eect, whereas the power
exceeded 0.99 for the detection of a moderate to large eect
size. us, there was more than adequate power (0.99) at the
moderate to large eect size level but less than adequate
statistical power at the small eect size level (Winnifred, 2009).
In Tab l e  1 , we report the sociodemographic characteristics
in detail.
RESULTS
Fear of COVID-19
From the analysis of the results of the fear of COVID-19
scale (see Table2) it emerged that there is a signicant dierence
between the score obtained from the participants in the research
and that reported by the normative sample. In fact, the
participants in the research relating to fear of COVID-19
obtained a lower score compared to the normative sample,
which refers to the rst wave of the pandemic (Servidio et al.,
2021). However, from the analysis of the t-test and ANOVA,
with reference to the results obtained from the participants
in the research, no signicant dierences emerged in the
sociodemographic variables of gender, age, marital status, current
work mode, and educational qualications.
General Health Questionnaire
As seen from the data reported in Tab l e  3 , regarding the
GHQ-12, the comparison with the normative sample shows a
signicant dierence. e participants in the research reported
higher levels of mental illness than the normative sample;
moreover, when the comparison with the normative data is
divided by gender, signicant dierences emerged. Both women
and men reported a higher level of malaise than those in the
female and male normative sample (Preti et al., 2007).
However, no signicant dierences emerge from the
comparison with the averages recorded during the rst waveof
the pandemic (Coppola et al., 2021, see Ta bl e  4 ). From the
Rania and Coppola COVID-19: Fear and Psychological Consequences
Frontiers in Psychology | www.frontiersin.org 5 February 2022 | Volume 13 | Article 805706
analysis of the results reported by the participants, there were
no signicant dierences in relation to age, gender, or
educational qualications.
Regarding marital status, however, a signicant dierence
emerged between those who were single (M = 7.3, SD = 3.11)
and those who were married/cohabiting (M = 6.45, SD = 2.98),
F(3, 493) = 4.27, p < 01,
h
p
2
= 0.03. e former report lower
mental wellbeing than the latter. With regard to the current
working mode, a signicant dierence emerged between those
who reported an unchanged mode (M = 6.43, SD = 2.74) and
those who were smart working (M = 6.35, SD = 3.27) or had
lost their jobs (M = 8.71, SD = 2.71). ose who continued to
work without changes reported lower mental wellbeing than
those who were smart working, but higher mental wellbeing
than those who lost their jobs, F(2, 293) = 5.11, p < 01,
h
p
2
= 0.033.
Loneliness
Regarding loneliness, signicant dierences emerged from the
comparison with the normative sample (Caputo, 2017, see
Ta bl e  5). e participants in the research reported a lower
level of loneliness than the normative sample. Similarly, a
signicant dierence emerged from the comparison with the
normative sample divided by gender with regard to women.
e participants in the research report a lower level of loneliness
than the women in the normative sample. No signicant
dierences emerged from the comparison between the male
participants in the research and the males of the normative sample.
Regarding the comparison between the averages recorded
during the rst wave of the pandemic and the data from the
participants in the research regarding loneliness, signicant
dierences emerged (Rania and Coppola, 2021, see Tab l e  6 ).
Both women and men reported a level of loneliness lower than
the average recorded during the rst wave of the pandemic.
From the analysis of the results reported by the participants
in the research, however, no dierences emerged in relation
to the current work mode and educational qualications. However,
dierences emerged with respect to the age groups, particularly
between those who were in the 18–24 age group (M = 5.46,
SD = 1.56) and those who were in the 25–34 age group (M = 4.86,
SD = 1.63), the 35–44 age group (M = 4.70, SD = 1.46), the 55–64
age group (M = 4.82, SD = 1.49), and those 65 or older (M = 4.44,
SD = 1.18), F(5, 491) = 4.58, p < 0.01,
h
p
2
= 0.05 Participants in
the 18–24 age group reported a higher level of loneliness.
Regarding marital status, the analysis of the results shows a
signicant dierence between those who are single (M = 5.26,
SD = 1.60), those who are married/cohabiting (M = 4.73, SD = 1.46),
and widowers (M = 4, SD = 0.58). e former shows a higher
level of loneliness than those who are married or widowed.
Furthermore, a signicant dierence emerges between those
who are divorced/separated (M = 5.23, SD = 1.76) and those w ho
are widowers (M = 4, SD = 0.58). e former reports a higher
level of loneliness than the latter, F(3, 493) = 4.27, p < 01,
h
p
2
= 0.03.
Positive Social Distance
Regarding the analysis of positive attitudes toward social
distancing during COVID-19, a signicant dierence in relation
to gender emerged from the comparison with the normative
sample (An et al., 2021, see Tab l e  7 ). e female participants
in the research obtained a higher score than the women in
the normative sample. Conversely, there were no signicant
dierences between the scores of the male participants and
the scores reported by the men in the normative sample. e
analysis of the results reported by the participants in the
research did not reveal any signicant dierences based on
gender, marital status, current work modes, or educational
qualications. Instead, a signicant dierence emerged in relation
to age, and in particular, between those who are in the age
25–34 group (M = 4.08, SD = 0.59) and those who are in the
age 45–54 group (M = 3.66, SD = 0.83) and 65 or older (M = 4.36,
TABLE2 | Fear of COVID-19 scale: comparison between the average values of
the participants and the average values of the Italian normative sample (Servidio
etal., 2021).
Fear of COVID-19 T (df) pCohens’ d
Participants Italian
normative
sample
during
COVID-19
M (DS) M (DS)
Total
sample
2.13 (0.75) 2.61 (0.87) 14.274
(496)
0.000 0.59
TABLE1 | Sociodemographic characteristics of the participants (N = 500).
Category variables %
Gender
Male 14
Female 86
Marital status
Unmarried 47.7
Married/cohabiting 44.7
Separate/divorced 6.2
Widower 1.4
Children
Participants with children 37.6
Participants without children 62.4
Educational qualication
Junior high school 1.2
Secondary school 41.9
Graduation 39
postgraduate specialization 17.9
Work arrangements during COVID-19
Unchanged 67.9
Smart working 26.4
Loss of job/work permit/leave 5.7
Age
M (SD) 39.52 (16.58)
18–24 26.2
25–34 24.1
35–44 10.9
45–54 12.9
55–64 16.9
65 or older 9
Rania and Coppola COVID-19: Fear and Psychological Consequences
Frontiers in Psychology | www.frontiersin.org 6 February 2022 | Volume 13 | Article 805706
SD = 0.46). e younger participants reported a positive attitude
toward social distancing higher than those who are in the
intermediate age group, but lower than older people. Furthermore,
there was a signicant dierence between those who are in
the age 35–44 group (M = 3.8, SD = 0.82) and the age 45–54
group (M = 3.66, SD = 0.83) and those who are in the age 55–64
group (M = 4.18, SD = 0.52) and 65 or older (M = 4.36, SD = 0.46),
F(5, 491) = 9.81, p < 0.01,
h
p
2
= 0.09. Older people report higher
positive social distancing scores than younger people.
Negative Social Distance
Compared to the analysis of negative attitudes toward social
distancing during COVID-19, a signicant dierence emerges
between the averages obtained from the male participants in
the research and those obtained from the male normative
sample (An et al., 2021, see Tab l e  8). e men of the normative
sample referred to during the rst pandemic period (An et
al., 2021) scored higher than the males participating in the
research. From the analysis of the results obtained by the
participants in the research, no signicant dierences emerged
related to gender, marital status, and educational qualications.
Instead, a signicant dierence emerged in relation to the age
groups, particularly between those who were 18–24 years old
(M = 2.48, SD = 0.78), 35–44 years old (M = 2.41, SD = 0.79), and
45–54 years old (M = 2.71, SD = 0.91) and those who are
55–64 years old (M = 1.93, SD = 0.68) and 65 or older (M = 1.84,
SD = 0.58). Older people scored lower for negative social
distancing than younger participants. Finally, a signicant
dierence also emerged between those who were 25–34 years
old (M = 2.22, SD = 0.73) and those who were 45–54 years old
(M = 2.71, SD = 0.91); the latter had greater negative attitudes
toward social distancing with respect to the former, F(5,
491) = 12.98, p < 0.01,
h
p
2
= 0.12.
Correlations and Regressions
From the analysis of the correlations reported in Tab l e  9 , it
is clear how the fear of COVID-19 correlates positively with
loneliness (r = 0.136, p < 0.01), the perception of mental illness
(r = 0.178, p < 0.01), and a positive attitude toward social distancing
(r = 0.161, p < 0.01). Loneliness correlates positively with the
perception of mental illness (r = 0.433, p < 0.01), with a negative
attitude toward social distancing (r = 0.184, p < 0.01).
Further investigation highlighted the factors aecting the
general health scale. e stepwise model selection in multiple
linear regression analysis that considered the GHQ-12 scale
as a dependent variable is presented in Table 10.
e model has an R2 = 0.199, which means that 20% of the
variance in the GHQ-12 scale is explained by the model. e
R2 value was statistically signicant. Loneliness (β = 0.122,
p = 0.01) and fear of COVID-19 (β = 0.122, p = 0.003) were
signicant predictors.
DISCUSSION
From the analysis of the results, it emerges that in this particularly
complex period, the perception of fear of COVID-19 aects
TABLE3 | Mental health comparison between the average values of the
participants and the average values of the Italian normative sample pre-COVID-19
(Preti etal., 2007).
GHQ-12 t(df) pCohens’ d
Participants Italian
normative
sample
M (DS) M (DS)
Total
sample
6.84 (3.04) 1.8 (2.3) 36.948 (496) 0.000
Male 6.67 (2.9) 1.4 (2.0) 15.09 (68) 0.000 2.11
Female 6.89 (3.05) 2.5 (2.6) 29.6 (422) 0.000 1.55
TABLE4 | Mental health comparison between the average values of the
participants and the average values of the rst wave (Coppola etal., 2021).
GHQ-12
Participants Italian sample during
COVID-19
M (DS) M (DS)
Male 6.67 (2.9) 6.01 (3.07)
Female 6.89 (3.05) 6.45 (3.04)
TABLE5 | Loneliness comparison between the average values of the
participants and the average values of the Italian normative sample (Caputo,
2017).
UCLA t(df) pCohens’ d
Participants Italian
normative
sample
M (DS) M (DS)
Total
sample
5 (1.56) 5.46 (2.06) 6.555 (496) 0.000 0.25
Male 4.8 (1.4) 4.94 (1.92) 8.484 (68) 0.399
Female 5.04 (1.58) 5.58 (2.08) 7.092 (422) 0.000 0.29
TABLE6 | Loneliness comparison between the average values of the
participants and the average values of the rst wave (Rania and Coppola, 2021).
UCLA t(df) pCohens’ d
Participants Italian
normative
sample
during
COVID-19
M (DS) M (DS)
Male 4.8 (1.4) 5.23 (1.71) 2.570 (68) 0.012 0.28
Female 5.04 (1.58) 5.68 (1.97) 8.394 (422) 0.000 0.36
Rania and Coppola COVID-19: Fear and Psychological Consequences
Frontiers in Psychology | www.frontiersin.org 7 February 2022 | Volume 13 | Article 805706
the levels of psychological wellbeing of the population.
Regarding the fear of COVID-19, the results show that compared
to the rst period of the pandemic, the participants in the
research perceive lower levels of fear of COVID-19. is change
may be because compared to the rst wave, the government
has implemented strategies to combat the spread of the virus,
including the development of vaccines, which the majority of
the population has received (Rania etal., in press); additionally,
there has been a reduction in the rate of mortality, as reported
by the National Institute of Statistics (Istat, 2021). It has also
emerged that the perception of fear of COVID-19, albeit at
lower levels than before, is an emotional state that has
overwhelmed the population regardless of gender, age, marital
status, current working modes, and educational qualications.
However, regarding perceived mental wellbeing, while the
participants show a lower mental wellbeing compared to the
normative sample, no signicant dierences emerge from the
data collected during the rst wave of the pandemic. ee
data are signicant as it highlights how the malaise has
signicantly increased during the pandemic, as highlighted by
several studies (Ahmed et al., 2020; Casagrande et al., 2020;
Ferrucci et al., 2020; Moccia et al., 2020; Tian et al., 2020;
Wang et al., 2020a,b; Yang and Ma, 2020; Rania and Coppola,
2021), and that it also remained high 1 year later despite the
various strategies implemented to counter the spread of the
virus. Furthermore, while there are no dierences regarding
the perception of mental health related to age group and gender.
is result diers from what was found by La Rosa et al.
(2021), who report how the women participating in their
research reported a higher level of traumatic stress than men.
Signicant dierences emerged in relation to marital status: a
dierence emerged between those who are single and those
who are married. e latter reported lower levels of mental
illness than the former. is may be because living with a
partner and family in general can be considered a source of
fundamental support, especially in situations where relational
dynamics are experienced in a positive and satisfying way (Li
and Wang, 2020; Parisi etal., 2021), particularly during moments
of great complexity (Pyari et al., 2012). Finally, dierences
also emerged regarding the mode of working during COVID-
19. ose who continued to work without changes in the
mode reported a lower level of mental health than those who
switched to smart working. is could bebecause the former
felt less protected from a health perspective than those who
were able to work from home; however, the most aected
were those who lost their jobs during this emergency phase—
they reported lower mental health scores. In fact, as highlighted
in the literature, having a job has been described as a protective
factor during the pandemic period (Li and Wang, 2020).
Regarding the construct of loneliness, from the analysis of the
results, it emerged that the perception of loneliness decreased
signicantly both when compared with the normative sample
and when compared with data collected during the rst wave
of the pandemic. ese results could bebecause following the
imposed lockdown phase, the participants sought social activities
in order to return to everyday life and cultivate their social
relationships, which were signicantly aected during the rst
phase of the pandemic, despite the availability of social networks.
Furthermore, from the results, it emerges that the youngest
reported higher levels of loneliness, as also found by previous
research (Li and Wang, 2020; Rumas et al., 2021), precisely
because those most dedicated to activity were the most aected
by the restrictions imposed. Finally, regarding marital status,
the data show how single and divorced/separated were the
most aected by loneliness; in fact, as also highlighted in the
literature, the presence and support received from a family
considerably inuence the perceived level of loneliness (Rania
and Coppola, 2021).
Regarding the positive attitude toward social distancing, the
female participants reported a higher score than the women
in the regulatory sample, showing a broader adherence to the
restrictions imposed 1 year aer their introduction into daily
life. is result is in line with what emerged from the research
conducted by An et al. (2021) and with the ndings of a
research conducted with a young population, which shows
that women from a young age are more likely to adhere to
the requests made by the authorities (Esposito et al., 2021).
Furthermore, contrary to what emerged from previous research
(An et al., 2021), a general positive attitude toward social distancing
emerges regardless of gender, marital status, current working
modes, and educational qualications. is attitude could belinked
to the fact that the population has witnessed the deleterious eects
TABLE7 | Positive attitudes toward comparison between the average values of
the participants and the average values of the Italian normative sample (An et al.,
2021).
Positive social
distance
t(df) pCohens’ d
Participants Italian
normative
sample
during
COVID-19
M (DS) M (DS)
Male 3.84 (0.89) 3.73 (0.97) NS 0.303
Female 4.04 (0.59) 3.94 (0.91) 3.624 (422) 0.000 0.13
TABLE8 | Negative attitudes toward social distance: comparison between the
average values of the participants and the average values of the Italian normative
sample (An et al., 2021).
Negative social
distance
t(df) pCohens’ d
Participants Italian
normative
sample
during
COVID-19
M (DS) M (DS)
Male 2.3 (1.0) 2.60 (1.13) 2.534 (68) 0.014 0.28
Female 2.28 (0.75) 2.29 (1.00) NS 0.821
Rania and Coppola COVID-19: Fear and Psychological Consequences
Frontiers in Psychology | www.frontiersin.org 8 February 2022 | Volume 13 | Article 805706
of the pandemic, and this could have contributed to greater
acceptance of the restrictions imposed. Finally, even with respect
to this dimension, the elderly report more positive attitudes toward
social distancing than the young, as also reported by previous
research (An et al., 2021). is may be because the mortality
rates caused by COVID-19 are higher among older people, who
are more exposed to the risk of contracting the virus and its
side eects (Onder et al., 2020). Regarding the negative attitude
toward social distancing from the analysis of the results, it emerges
that the men participating in the research obtained a lower score
than the normative sample (from the rst period of the pandemic).
is could bebecause, over time, people have become accustomed
to the imposed social distancing and have introjected this measure,
perceiving it as a necessity to counter the spread of the virus.
e results show that young people between 18 and 24 years old
reported a higher score in this dimension than the elderly. is
is probably because young people have been most socially aected
by the health crisis, as founded by some research carried out in
the era of COVID-19 (Cao et al., 2020; Li and Wang, 2020).
Furthermore, as noted by Higuchi et al. (2020), staying at home
has led to an excessive use of technologies in young people in
particular. Furthermore, from the analysis of the correlations, there
are positive correlations between the fear linked to COVID-19
and the perception of loneliness, mental health, and positive social
distancing. In fact, the fear of COVID-19 leads to a favorable
perception of social distancing to isolate oneself and consequently
to perceive a low level of mental health. From the regression
analysis, it emerges just how fear of COVID-19 and loneliness
are predictors of perceived mental health, inuencing people’s
wellbeing. In this regard, Soraci et al. (2020) report that during
other epidemics, some authors found associations between disorders,
such as anxiety and depression and fear, which compromised the
quality of life (Ford etal., 2018; Huang and Zhao, 2020a, 2020b),
and note that these associations also occur in the current epidemic
due toa social isolation, which had previously been shown to
be strongly connected with anxiety and depression in both young
and old individuals (Matthews et al., 2019; Santini et al., 2020).
CONCLUSION
is study focused mainly on analyzing the fear of COVID-19
and social distancing and the repercussions on mental wellbeing
and perceived loneliness by the participants. Although the study
conducted represents an opportunity to illuminate the
psychological consequences of the health crisis, there are limits
that should be emphasized. e main limitation is due to the
method of administration. While the online questionnaire made
it possible to reach a larger number of participants, the lack
of a predened setting in which to dedicate themselves to
completing it may have led the participants to provide careless
answers (Ward et al., 2017). Furthermore, the use of the online
questionnaire may have hindered the participation of some
sections of the population less inclined to use technology.
Moreover, although a large number of participants joined the
research, it should beemphasized that there was an imbalance
in participation in favor of women, as oen happens in this
type of research (Søgaard et al., 2004; Rania and Coppola,
2021); nally, while believing that this research helps to bring
out the impact that COVID-19 has had on the mental health
of the population, it should beemphasized that by not employing
questions or exclusion criteria based on the presence of psychiatric
or psychological comorbidities, it cannot beexcluded that some
participants may have previous psychological or psychiatric
pathologies unknown to us. Despite these limitations, some
strengths are represented by the fact that this research has
made it possible to highlight how COVID-19 has led to
nonnegligible psychological consequences even 1 year aer the
most critical phase; moreover, the large number of participants,
who joined voluntarily and without any type of reward, made
it possible to determine dierences related to some
sociodemographic variables analyzed, including age, marital
status, and work modes. To conclude, the results emerging
from this research should make policymakers reect on the
need to nd containment strategies and tools for this pandemic
or other health crises that have a limited impact on the
sociopsychological wellbeing of the population.
DATA AVAILABILITY STATEMENT
e datasets presented in this article are not readily available
because the datasets generated for this study cannot be shared
for ethical reasons related to privacy; however, the authors
will attempt to make the data available for valid requests.
Requests to access the datasets should be directed to NR,
nadia.rania@unige.it.
TABLE9 | Correlations between the constructs investigated.
1234 5
1. UCLA_
TOT
10.433** −0.069 0.184** 0.136**
2.GHQ_TOT 0.433** 10.063 0.074 0.178**
3. DIST_
SOC_POS
0.069 0.063 1 0.715* *0.161**
4. DIST_
SOC_NEG
0.184** 0.074 0.715** 10.063
5. FEAR OF
COVID-19
SCALE
0.136** 0.178** 0.161** −0.063 1
**The correlation is signicant at the 0.01 (two tailed) level.
TABLE10 | Regression model: General health (GHQ-12) as dependent variable.
Variables*B SE Beta tR2
Adj
1. UCLA_
TOT
0.810 0.079 0.417 10.27
2. FEAR OF
COVID-19
SCALE
0.492 0.164 0.122 3 0.199
*In this model, the negative and positive social distance variables have been included
but excluded from the model.
Rania and Coppola COVID-19: Fear and Psychological Consequences
Frontiers in Psychology | www.frontiersin.org 9 February 2022 | Volume 13 | Article 805706
ETHICS STATEMENT
Ethical review and approval was not required for the current
study in accordance with the local legislation and institutional
requirements. Research was carried out in accordance with
the Ethics Research Recommendations of the American
Psychological Association (APA) and in accordance with
the Declaration of Helsinki. Participation was entirely
voluntary, confidential and anonymous. The participants
were informed that they were free to withdraw from the
study at any time. The patients/participants provided their
written informed consent to participate in this study.
AUTHOR CONTRIBUTIONS
NR: conceptualization, visualization, supervision, and project
administration. NR and IC: methodology, formal analysis,
investigation, data curation, writing—original dra preparation,
and writing—review and editing. All authors have read and
agreed to the published version of the manuscript.
ACKNOWLEDGMENTS
We thank the participants who made this research possible.
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The COVID-19 pandemic has created a global context in which social isolation has become normative in order to reduce the risk of COVID-19 transmission. As a result of social distancing policies, the risk for loneliness and associated decline in quality of life has increased. The current study examined factors associated with loneliness and quality of life during the COVID-19 pandemic cross-sectionally (n = 797) and longitudinally (n = 395). Older age and larger social network size were associated with less loneliness, whereas having multiple physical or mental health diagnoses was associated with greater loneliness. Greater virtual social contact was also associated with increased loneliness. Greater loneliness was associated with all domains of quality of life both cross-sectionally and longitudinally. Understanding factors associated with loneliness is critical to developing effective strategies at reducing loneliness and improving quality of life during the pandemic. Contrary to popular perceptions, older age was associated with less loneliness and more virtual social contact was associated with more loneliness. Thus, it may be prudent to deemphasize virtual social contact in public campaigns and to emphasize safe methods of interacting in person.
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Little is known about the impacts of covid-19 pandemic on mental health problems among youth population whereas this information is extremely necessary to develop appropriate actions to support these young people overcoming psychological crisis and increasing satisfaction with life during the disease outbreak. This study not only explores the influences of fear and anxiety of covid-19 on life satisfaction, but it also examines the mediating roles of psychological distress and sleep disturbance in this linkage. 1521 students from universities in Vietnam was assessed utilizing the online-based cross-sectional survey. The study revealed that fear and anxiety of covid-19 was strongly related to psychological distress and sleep disturbance and life satisfaction among Vietnamese university students. Also, life satisfaction was found to have a strong and negative association with psychological distress, but without sleep disturbance. Moreover, the findings of the study revealed that fear and anxiety of covid-19 reduced life satisfaction and increased sleep disturbance via psychological distress. This study was expected to contribute to the extant literature by enriching our understanding the serious impacts of covid-19 pandemic on youths' mental health as well as provide some useful references for policy makers to prevent the occurrence of psychological crisis among university students.